Objectives: To evaluate epidemiological characteristics and outcome of invasive aspergillosis (IA) in acute myeloid leukaemia patients (AMLs) and to analyse efficacy of different therapeutic approaches.

Methods: A survey was conducted over 20042007 in 21 Italian Haematology Divisions. All proven/probable IA were reported. AMLs submitted to transplant were excluded. The parameters we analyzed were: age, sex, AML phase, site of IA, severity, duration and recovery from neutropenia, antifungal prophylaxis, empirical/pre-emptive therapy, 1st/2nd line target therapy, aetiologic agent, G-CSF use, neutrophil transfusion, outcome. We also collected date of symptoms onset, diagnosis, antifungal therapy start and exitus. All variables were investigated as predictors of death. Follow up was assessed at 90th day from diagnosis.

Many pts received systemic prophylaxis (72%); itraconazole and fluconazole were used in 68 and 33 pts respectively. No differences emerged between empirical vs pre-emptive therapy and none of the drugs resulted to significantly influence outcome. In 66% of pts initial empirical/pre-emptive drug remained unchanged after IA diagnosis, while in 16% clinicians shifted to a combined treatment.

Conclusion: This study allows as to analyzed multiple factors as potentially influencing outcome. We confirmed that AML phase and neutropenia influence IA outcome. Present data confirm the perception that during last years the application of a correct and timely diagnostic work-up and the availability of more efficacious and less toxic drugs (i.e. voriconazole, liposomal amphotericin B, caspofungin) have modified the course of IA. However none of the new drugs emerged as the most efficacious in our series. Even combined treatment did not confer any advantage in survival analysis.

AMLs

Deaths (AMR%)

p value

Systemic prophylaxis

Not administered

39

8 (20.5)

0.27

Administered

101

30 (30)

Empirical/pre-emptive

Caspofungin

28

9 (32)

L-AmB

54

12 (22)

Itraconazole

5

2 (40)

0.79

Voriconazole

25

6 (24)

Other

16

5 (31)

Not done

12

4 (33)

First-line therapya

Caspofungin

28

9 (32)

L-AmB

37

9 (24)

0.65

Voriconazole

38

7 (18)

Combined

22

5 (23)

Other

11

4 (36)

a4 early deaths

Session Details

Date:

16/05/2009

Time:

00:00-00:00

Session name:

19th European Congress of Clinical Microbiology and Infectious Diseases